[Primary omental torsion in preschool girls case report]. / Primární torze omenta u dívek predskolního veku kazuistika.

INTRODUCTION: Primary omental torsion is a rare finding in cases of suspected acute abdomen. It is more common in children. Secondary omental torsion is typical for adults. CASE REPORT: The authors describe two cases where pain in the right upper abdominal quadrant was caused by primary torsion of the omental corner due to increased intraabdominal pressure: after a strong cough in one girl and after a workout in the other. Primary omental torsion usually mimics acute appendicitis with clinical findings in the right lower abdominal quadrant, especially in obese children. However, our two cases describe normosthenic girls with pain in the right upper abdominal quadrant up to the mesogastrium. CONCLUSION: Primary torsion of the omentum is a very rare cause of acute abdomen, which is also confirmed by its incidence in our group of patients where only two cases were seen during a 15-year period, which corresponds to 0.17% of all appendectomies performed in our department. This value is comparable to data reported in the literature. KEY WORDS: acute abdomen omental torsion tenderness in right upper abdomen.

[Intestinal volvulus caused by the ingestion of magnet balls: unexpected risk in children]. / Strevní volvulus zpusobený pozitím magnetických kulicek: neocekávané riziko u detí.

INTRODUCTION: The occurrence of swallowed foreign bodies in the digestive system is a common problem in children with the highest incidence in children aged six months to five years. Most swallowed objects leave the human body per vias naturales while 10-20% of swallowed foreign bodies need to be removed with an endoscope. Serious and life-threatening situations are caused by the ingestion of foreign bodies in about 1% of all cases. CASE REPORT: The authors present a case of a two-year-old girl diagnosed with acute abdomen for which she was operated on. A small bowel volvulus and several intestinal fistulas were found intraoperatively. The cause of this finding was the ingestion of magnetic balls and a swallowed metal body drawn to them by magnetic force. CONCLUSION: If more than one magnetic body is ingested, it is necessary to admit the patient to hospital and to remove these foreign bodies using an endoscope. The position of the magnets which is not changing in a location inaccessible for an endoscope during 2448 hours is an indication for urgent operation.

[Seat-belt syndrome in a pre-school child]. / Seat-belt syndrom u predskolního dítete.

The authors report on a pre-school child with a typical presentation of the trauma caused by a car safety belt and termed the seat-belt syndrome. The deceleration mechanism which throws the upper body forward in the presence of a rigid belt over the abdominal region results in large contusions of the abdominal wall and trauma to the spine, retroperitoneum, and intra-abdominal organs, or even the chest. In making the diagnosis a thorough examination of the spine is necessary as well as a repeated surgical examination of the abdomen, because seat-belt syndrome is often associated with small intestine rupture, a symptom which can remain unrecognised at the early stage. In the case of a four-year-old boy described here, two loops of the small intestine were resected for perforation; stabilization of the vertebral column was indicated on the 5th post-injury day because of decompensated diabetes and deteriorated health state following intra-abdominal surgery. In this boy, poor compensation of juvenile diabetes resulted in infectious complications requiring repeated drainage of an abscess of the abdominal wall injured by the seat belt.The abdominal wall healed within 2 months, diabetes was managed with insulin therapy and good spondylodesis was achieved at 9 months after the injury.

[Antibacterial chemotherapy--are we really at the end of the antibiotic era?]. / Antibakteriální chemoterapie--jsme skutecne na konci antibiotické éry?

Antimicrobial chemotherapy undergoes a global crisis. The nineties brought the unprecedented spread of resistance of main pathogenic bacteria to antibiotics, with an extent and intensity varying from negligible to threatening, depending largely on the local or regional or nationwide approach to prescribing antibiotics. In some reqions the microbial multiresistance led to various bacterial infections becoming untreatable, however, substantial increase of costs of antibacterial chemotherapy--somewhere even prohibitive--has been felt everywhere, depending on the necessity of using reserve drugs instead of basic ones. In he mid of nineties, the advent of a post-antibiotic era seemed almost inevitable. Concentrated efforts aimed at rationalizing the antibiotic usage, at decreasing the useless prescribing, at creating antibiotic policies as well as the development of new at the antibacterials have diminished the danger, at least for some time. Brief descriptions of new drugs (linezolide, quinupristine/dalfoprostine, new chinolones and naphythyridones and telithromycine) are given and some other, in the near future possibly useful antibacterials (daptomycine, glycycyclines, oral carbapenems and trinems) are mentioned as well as some new ways of antibacterial research. In a long-term view, however, rationalization of antibiotic prescribing is the only and irreplaceable mean of maintaining the efficacy of antibacterial chemotherapy at acceptable costs.

[Lincosamide antibiotics]. / Linkosamidová antibiotika.

A survey of microbiological and pharmacological properties of, of clinical experience with and of untoward reactions of lincomycin and clindamycin has been presented. Both antibiotics are active against gram-positive aerobic and many anaerobic bacteria. As to anti-anaerobic activity, clindamycin is superior to lincomycin. Consequently, anaerobic infections are main indication for clindamycin in clinical practice. On the other hand, lincomycin shows excellent penetration into body fluids and tissues and its dosage can be adapted to actual clinical situation in a very wide range. Recently, combinations of clindamycin with other drugs have proved effective in the treatment of falciparum malaria as well as of acute toxoplasmosis and Pneumocystis pneumonia in AIDS patients. Both lincomycin and clindamycin play still an important role in chemotherapy of infections.

[Spiramycin]. / Spiramycin.

Spiramycin is a 16-membered ring macrolide (antibiotic). It was discovered in 1952 as a product of Streptomyces ambofaciens. As a preparation for oral administration it has been used since 1955, in 1987 also the parenteral form was introduced into practice. The antibacterial action involves inhibition of protein synthesis in the bacterial cell during translocation. Resistance to spiramycin can develop by several mechanisms and its prevalence is to a considerable extent proportional to the frequency of prescription in a given area. The antibacterial spectrum comprises Gram-positive cocci and rods, Gram-negative cocci and also Legionellae, mycoplasmas, chlamydiae, some types of spirochetes, Toxoplasma gondii and Cryptosporidium sp., Enterobacteria, pseudomonads and pathogenic moulds are resistant. Its action is mainly bacteriostatic, on highly sensitive strains it exerts a bactericide action. As compared with erythromycin, it is in vitro weight for weight 5 to 20 less effective, an equipotential therapeutic dose is, however, only double. This difference between the effectiveness in vitro and in vivo is explained above all by the great affinity of spiramycin to tissues where it achieves concentrations many times higher than serum levels. An important part is played also by the slow release of the antibiotic from the tissue compartment, the marked action on microbes in sub-inhibition concentrations and the relatively long persisting post-antibiotic effect. Its great advantage is the exceptionally favourable tolerance-gastrointestinal and general. It is available for parenteral and oral administration.(ABSTRACT TRUNCATED AT 250 WORDS)

[Clinical and pharmacologic review of antiviral agents]. / Klinický a farmakologický prehled virostatik.

The author presents a review if pharmacokinetics, undesirable effects, drug interactions, dosage, indications and drug forms of antiviral chemotherapeutic agents used for systemic treatment: amantadine and rimantadine (influenza virus A), acyclovir (HSV-1, HSV-2 and VZV), ganciclovir (CMV), zidovudine (HIV), ribavirine (broad spectrum) and fosfocarnet (herpes viruses and HIV), mentioning also vidarabine. All mentioned preparations are at least in some countries commercially available. The author does not mention virostatic agents used only locally and preparations which are at present in the stage of clinical tests.

[Clinical experience with Timentin]. / Klinické zkusenosti s lécbou Timentinem.

BACKGROUND: A combination of ticarcillin with clavulanate has been used for more than 12 years in many countries in the treatment of infections caused by Gram-negative microorganisms and a mixed microbe flora, in particular where the presence of beta-lactamase producers can be anticipated. In the Czech Republic it is not very well known, probably more for commercial than medical reasons, and the objective of the present paper to draw attention to this old but still useful antibiotic. METHODS AND RESULTS: In a simple open trial the therapeutic results in a group of 15 patients treated by the above preparation in 1992-1995 at the unit for septic infections of the Clinic for Infectious Diseases in Prague were summarized and compared with the results of a previous trial conducted in the same department in 1987-91 and with results published in the literature. The mean success of treatment was about 90%. CONCLUSIONS: A combination of ticarcillin, a semisynthetic broad spectrum penicillin with clavulanic acid is an antibiotic which is still very valuable in the treatment of sepsis and other severe forms of bacterial infection, incl. patients with a significantly reduced immunity. The tolerance is very good and an important factor is also the relatively favourable price. The author's results are consistent with experience published by departments abroad.

[Tracheobronchial injuries--experience with diagnosis and therapy]. / Tracheobronchiální poranení--zkusenosti s diagnostikou a lécbou.

The incidence of penetrating injuries of the respiratory pathways is permanently low and relatively stable, on the other hand, it may be assumed that there is an increasing rate of tracheobronchial injuries during blunt accidents of the chest in particular in conjunction with the increased rate of traffic injuries. Serious injuries are involved, in particular because of their high morbidity and mortality; frequently they are part of associated injuries and polytraumas. In 1999-2002 at the Surgical Clinic of the Plzen-Lochotín Faculty Hospital a penetrating stab wound of the cervical trachea was treated in an 11-year-old boy and injuries of the large bronchi of adult men resulting from blunt chest injuries during car accidents. All three injuries were associated with a typical symptomatology of pneumocolon and pneumomediastinum, or persistent pneumothorax and respiratory complaints resp. The definite diagnosis was established in two instances shortly after admission, based on results of CT and bronchoscopic examination, in the case of the injury of the middle bronchus only on the following day during surgical revision combined with preoperative bronchoscopy. Treatment was surgical in all instances. Twice the lesion was sutured, in one case pulmonary resection was performed. No significant postoperative complications were observed nor any deaths. The main factors which influence in a decisive way the prognosis of the casualty and the therapeutic result are in the authors' opinion, consistent with data in the literature, early assessment of the diagnosis of tracheobronchial injury and early adequate therapeutic action. In the diagnosis a dominant position is held in addition to CT in particular by treacheobronchoscopy. In case of surgical treatment reconstruction operations are preferred.

Alkaline and alkaline/oxidation pre-treatments of spruce wood (Picea abies)--impact on the quality of kraft pulp.

A comparable series of specimens from spruce wood were pre-treated with sodium hydroxide, sodium hydroxide and hydrogen peroxide, or per-acetic acid sequences. The pre-treatments reduced the yield of pulps and their Kappa number noticeably, diminished the degree of polymerization moderately, and increased their brightness. One-step peroxide bleaching of pulps from the pre-treated spruce wood resulted in their higher brightness compared to bleached pulp from sound wood. From the viewpoint of improved properties of pulp, the most efficient were the sodium hydroxide/per-acetic acid and per-acetic acid/sodium hydroxide sequences. The pre-treatments did not influence mechanical strength of the obtained pulps significantly.